|
In general, we tell our cataract patients: "You will need to wear glasses
after the cataract extraction procedure for either distance or reading vision or
both in order to get the best possible vision. You should carefully discuss with
your doctor any questions you have about how your vision will be with and
without glasses. You and your doctor make a plan together to best fit your
needs." 
In an attempt, however, to improve the
uncorrected vision at near, far and intermediate distances, there are exciting
new lens implants available for use in conjunction with cataract surgery.
Normally, lens implants have a fixed focus distance (see
Refractive Goals). But the unique optics
of the
ReStor®
and
the ReZoom®
are able to actually shift focus between near and far, providing excellent
vision near and far in over 75% of cases without glasses. The patients who are
most suited for these implants must have little or no astigmatism pre-operatively, and no
other eye disease, in order to increase the chances of success with this lens
implant. The surgery must go perfectly, and the pre-operative measurements must
give precise results in order to achieve this result. Both of these lenses are
available at MarinEyes. Your surgeon will advise on the choice of lens based
upon your particular needs.
Medicare has recently approved the option for MediCare
patients undergoing cataract surgery to upgrade to this new type of lens implant.
Both the Restor and the ReZoom lens are available to our patients regardless of
insurance type at additional out-of-pocket expense. The best candidates for this lens will have
a desire to see well without glasses, little astigmatism and otherwise healthy eyes.
Ask your surgeon if you are a candidate for one of these lenses.
There are other options available to
compensate for presbyopia:
Eyeglasses: Bifocals, progressive
lenses and trifocals are the most common correction, and allow for correcting
astigmatism as well as near- or far-sighted results. They are safe, effective
and highly reliable.
Monovision: People who have worn "monovision" contacts,
or who naturally have one distance eye and one focused for near are good
candidates to have one eye corrected far and one for near in the selection of
the implant for their cataract surgery. Glasses may still be helpful for such
activities as night driving and prolonged reading.
Accommodating lens
implants: For
completeness, we mention the "Accommodating" type of lens.
It attempts to correct presbyopia using a different technology from the
multifocal IOL's. Presently the only
lens in this class is the
CrystaLens®.
There will be “out-of-pocket” expenses not covered by insurance for patients
electing to have this type of lens. The best candidates for these
lenses will have little astigmatism and otherwise healthy eyes. We are not
currently recommending this lens at MarinEyes.
There are potential known and unknown
risks with any new technology. You must discuss this with your surgeon:
Any and all of the usual
potential problems
after cataract surgery can be encountered.
"Perfect" results of your implant power calculation are NOT
100% predictable. Laser refractive surgery (LASIK, for example) is more
predictable. Nonetheless, there are some ways to try to get more consistently
CLOSER to the exact power prediction for your lens implant. At MarinEyes, our
technicians are thoroughly trained and very careful. The measuring devices we
use include the IOL Master, a laser scanning device to measure the length and
curvature of your eye. We also use a method called "Immersion A-Scan" on some of
our patients. These methods are more accurate than the more commonly used
"Contact A-Scan." To supplement the curvature measurements from our IOL Master,
we use "Manual Keratometry" when indicated. Our new 3-D Wave scanning laser ("Wavefront technology") adds to the tools we use to measure corneal
curvature and analysis of optical aberrations in the eye. In instances where the
refraction results are not ideal, LASIK may be helpful in
adjusting for the unexpected result. Another option is a thin "piggyback" lens
implant.
Glare and Haloes:
Some patients will notice glare and or haloes with these lenses generally at
night, for example when driving. This type of lens implant is best for people
who do not anticipate doing a lot of night driving.
Astigmatism: Astigmatism will
diminish the effectiveness of Crystalens, and the best candidates have little or
no astigmatism. Should astigmatism appear after the surgery, additional laser
treatment (LASIK) may be an option to correct this.
Cataract Surgery after LASIK is a special problem: The
instruments and IOL power calculation formulas available today DO NOT give
uniform accuracy in selecting the correct implant power for patients undergoing
cataract surgery. We use a combination of methods to make the best estimate,
including use of old records, careful measurements and special implant power
calculation formulas. Refractive "surprises" can still happen, making
patients who have had refractive surgery worse candidates for the Crystalens®.
[TOP]
|
